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OBJECTIVE@#To investigate the early and middle stage efficacy and complications of minimally invasive extraperitoneal oblique lumbar interbody fusion (OLIF) in the treatment of degenerative lumbar diseases.@*METHODS@#The clinical data of 22 patients with degenerative lumbar diseases underwent OLIF from October 2017 to March 2019 were retrospectively analyzed, including 14 males and 8 females, aged from 51 to 72 years with an average of (63.15±7.22) years. There were 6 cases of lumbar spinal stenosis, 5 cases of lumbar spondylolisthesis, 4 cases of adjacent vertebral disease, 3 cases of degenerative lumbar scoliosis, 3 cases of discogenic low back pain, and 1 case of recurrence after posterior lumbar decompression. Posterior minimally invasive pedicle screw fixation was performed in 13 cases and Stand-alone fixation in 9 cases. Intraoperative blood loss, operation time, postoperative drainage volume, landing time were recorded. The intervertebral disc height(IDH), intervertebral foramen height(IFH), intervertebral foramen area( IFA), canal diameter(CD), canal area(CA) were measured before and after operation. The imaging changes (including location of fusion cage, interbody fusion, and cage subsidence) and complications were observed. Oswestry Disability Index (ODI), numerical rating scales (NRS) and Japanese Orthopaedic Association (JOA) scores were compared before and 3, 6, 12 months after operation.@*RESULTS@#All 22 patients successfully completed the operation. The intraoperative blood loss was 25 to 280 ml with an average of (95.45±79.07) ml and that of simple anterior approach was 25 to 70 ml with an average of (45.71±15.42) ml. The operation time was 75 to 210 min with an average of (137.72±37.66) min, and the simple anterior operation time was 75 to 105 min with an average of (91.40±15.96) min. The total drainage volume was 10 to 110 ml with an average of (56.23±31.15) ml, and the time to go down to the ground was 24 to 72 hours (54.48±18.24) hours after operation. Postoperative IDH improved (6.63±2.61)mm(P<0.05), the IFH improved (5.35±2.47)mm (P<0.05), the IFA improved (97.67±33.58)mm2(P<0.05), the CD improved (3.31±1.61) mm(P<0.05), the CA improved (57.52±31.39) mm2(P<0.05). Five patients got interbody fusion at 6 months after operation and all 22 patients got interbody fusion at 12 months after operation. There was 5 cases of fusion cage subsidence, all of which occurred in the cases without posterior fixation(using Stand-alone fixation). There was no serious complication such as big blood vessel injury, ureter injury, dural sac injury and nerve root injury. Peritoneal injury occurred in 1 case, postoperative transient thigh pain, decrease of quadriceps femoris muscle strength in 4 cases and sympathetic nerve injury in 1 case. The symptoms of lumbago and radicular pain of lower extremities were alleviated obviously 3 days after operation. The ODI, NRS and JOA scores at 6, 12 months after operation were significantly improved(P<0.05).@*CONCLUSION@#The treatment of lumbar degenerative diseases with definite indications by OLIF can achieve satisfactory clinical results, and it has advantages of less intraoperative bleeding, fast time to land, less complications, good imaging improvement and indirect decompression. But the operation time and fluoroscopy time are longer in the early stage, and complications such as peritoneal injury and lumbar plexus over traction may occur. The long-term incidence of settlement of fusion cage with Stand-alone technology is higher.
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Aged , Female , Humans , Male , Middle Aged , Lumbar Vertebrae/surgery , Retrospective Studies , Spinal Fusion/methods , Spondylolisthesis/surgery , Treatment OutcomeABSTRACT
Objective To explore the mechanism of HSP70 on cell cycle regulation in hepatic IR (ischemia-reperfusion) injury.Methods SD rats were randomly divided into HSP70 inhibitor group (H-/P+),heat shock group (H+/P+),PARP-1 inhibitory group (H +/P-),IR group (PC) and negative control group (NC),respectively.After the IR model was induced,the liver specimen underwent IHC staining to observe the changes of the PARP-1 expression;Co-immunoprecipitation was used to detect the binding of HSPT0 with PARP-1.Results H +/P-was significantly different from H +/P +,H-/P +,PC,NC (P ＜ 0.01);Immunoprecipitation suggested that HSP70 entered into the nucleus to bind PARP-1,and immunofluorescence imaging analysis demonstrated both HSP70 and CyclinD1 expressed at the same timeline.Conclusion Under reversible hepatic ischemia-reperfusion injury,HSP70 enters the nucleus and binds to PARP-1,negatively regulates G2/M phase,blocks cells for DNA replication and recombination,blocks its entry into mitosis,repairs damaged DNA chain;Liver ischemia-reperfusion positively regulates the G1/S phase,promoting hepatocyte regeneration and liver function compensation.
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·AIM: To investigate the prevalence of myopia among primary and middle school students aged 7 to 18 in Longkou City, Shandong Province, and to provide a scientific basis for prevention and control of myopia. ·METHODS: The students aged 7 to 18 were enrolled through the method of stratified random and cluster sampling by the unit of schools and were investigated in Longkou, Shandong Province in 2015. A total of 58 schools were selected and 61 036 students were effectively sampled. All the subjects were divided into three- tiers based on geographical location: urban, rural-urban continuum, and rural areas. All the subjects were examined with the visual acuity and non -cycloplegic objective fraction. Microsoft Excel worksheet was used to establish a database, and SPSS 21. 0 software was used for statistical analysis. ·RESULTS: The prevalence of total myopia in the sample population of students of Longkou in 2015 was 49. 81% from 7 to 18 years old. The overall prevalence of myopia increased fastest from 11 to 12 years old. And the prevalence of mild myopia of students aged 13 was highest. The prevalence of total myopia were 46. 41% for boys and 53. 39% for girls, which showed the prevalence of girls was higher than the boys'. The prevalence of myopia in urban, rural- urban continuum, and rural areas were 55. 18% , 49. 75% , 44. 47% , respectively, and the prevalence of myopia in urban areas was the higher than the rural-urban continuum and the rural areas. The prevalence of total myopia gradually increased with age (rs=0. 943, P<0. 05). ·CONCLUSION: The results of the investigation showed a high prevalence of myopia among primary and middle school students in the city of Longkou, and gradually increased with age. The overall myopia prevalence for girls was higher than boys, and the prevalence was highest in urban areas.
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Objective To explore the correlation of disease activity with the primary syndromes of deficiency and excess types of lupus nephritis(LN). Methods A retrospective study was carried out in 134 LN patients,and the LN patients were differentiated into deficiency syndrome(deficiency group)and excess syndrome(excess group). The disease activity related indicators of systemic lupus erythematosus disease activity index(SLEDAI)scores, complements, inflammation indexes, and urine indicators were compared between the two groups. Results Of the 134 LN patients,33 cases were differentiated into excess syndrome,and 101 cases were differentiated into deficiency syndrome. According to the SLEDAI scores, 9.09％ of the patients in excess group were inactive, 4.95％ of the patients in deficiency group were inactive, and most of the patients in the two groups were at severe active stage. There was no significant difference of SLEDAI scores between the two groups(P>0.05) . The differences of complement C3 and C4 , inflammation indexes of C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR),urine protein,and urine occult blood were also insignificant between the two groups (P>0.05). Conclusion There is no correlation between deficiency-excess syndrome differentiation and disease activity of LN. Most of the LN patients with deficiency syndrome are at active stage,but not at remission stage.
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BACKGROUND: The posterior anatomical locking plate has obtained excellent fixing performance in the treatment of complex fractures of the distal tibia; however, there are many drawbacks such as nail and plate broken, and the related rules are never reported. OBJECTIVE: To establish a finite element model of posterior anatomical locking plate for distal tibia and to provide references for its design and improvement. METHODS: The imaging data of a male patient aged 34 years old (body mass: 68 kg) with fracture on the left distal tibia were imported into Mimics16.01 software, and the proposed reconstruction parts were determined based on the default threshold of the software. The files were imported into the Ansys11.0 software, the distal tibial surface was fixed, and a force of 340 N was vertically loaded on the supine surface of the horizontal section of the large tibial shaft. RESULTS AND CONCLUSION: There was completely connected with the stepped surface of nut and screw thread portion in locking steel plate. The strain on the plate depended on the stress values. The posterior anatomical locking plate for distal tibia was more favorable for the fixation at the fracture site and could reduce the fixed plate and screws loosening, both of which could affect the fixed efficacy.
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Objective To design and manufacture a Shenmen point electronic stimulator and determine its therapeutic effects for insomnia and anxiety.Methods The stimulator was composed of a single point electrode unit and an electronic stimulation generator.The single point electrode unit consisted of a circular transdermal patch and two circular electrodes which was used for precision stimulation on Shenmen point.The electronic stimulation generator released low-frequency square-wave pulse current based on specific parameters to treat the examinees with insomnia and anxiety.The curative effect of the stimulator was tested by Hamilton rating scale for anxiety and evaluation on improved sleeping.Results The stimulator executed precision stimulation based on specific requirements on the point.30-min treatment with the stimulator before sleeping in 10 d contributed to significantly decreasing Hamilton rating scores for anxiety and improving sleeping quality.Conclusion The stimulator markedly attenuates anxiety and insomnia,and can be a convenient,effective and safe choice for adjunctive therapy of insomnia and anxiety.
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Objective To design and manufacture a Shenmen point electronic stimulator and determine its therapeutic effects for insomnia and anxiety.Methods The stimulator was composed of a single point electrode unit and an electronic stimulation generator.The single point electrode unit consisted of a circular transdermal patch and two circular electrodes which was used for precision stimulation on Shenmen point.The electronic stimulation generator released low-frequency square-wave pulse current based on specific parameters to treat the examinees with insomnia and anxiety.The curative effect of the stimulator was tested by Hamilton rating scale for anxiety and evaluation on improved sleeping.Results The stimulator executed precision stimulation based on specific requirements on the point.30-min treatment with the stimulator before sleeping in 10 d contributed to significantly decreasing Hamilton rating scores for anxiety and improving sleeping quality.Conclusion The stimulator markedly attenuates anxiety and insomnia,and can be a convenient,effective and safe choice for adjunctive therapy of insomnia and anxiety.
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The opening of mitochondrial permeability transition pore (MPTP) plays a critical role in platelet activation. However, the potential trigger of the MPTP opening in platelet activation remains unknown. Inflammation is the crucial trigger of platelet activation. In this study, we aimed to explore whether and how the important inflammatory cytokine IL-17 is associated with MPTP opening in platelets activation by using MPTP inhibitor cyclosporine-A (CsA). The mitochondrial membrane potential (ΔΨm) was detected to reflect MPTP opening levels. And the platelet aggregation, activation, and the primary signaling pathway were also tested. The results showed that the MPTP opening levels were increased and Δψm reduced in platelets administrated with IL-17. Moreover, the levels of aggregation, CD62P, PAC-1, P53 and the phosphorylation of ERK2 were enhanced along with the MPTP opening in platelets pre-stimulated with IL-17. However, CsA attenuated these effects triggered by IL-17. It was suggested that IL-17 could induce MPTP opening through ERK2 and P53 signaling pathway in platelet activation and aggregation.
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Humans , Blood Platelets , Cell Biology , Metabolism , Cell Separation , Cyclosporine , Pharmacology , Dual Specificity Phosphatase 2 , Genetics , Metabolism , Gene Expression Regulation , Interleukin-17 , Metabolism , Pharmacology , Membrane Potential, Mitochondrial , Mitochondria , Metabolism , Mitochondrial Membrane Transport Proteins , Genetics , Metabolism , Mitogen-Activated Protein Kinase 1 , Genetics , Metabolism , P-Selectin , Genetics , Metabolism , Phosphorylation , Platelet Activation , Platelet Aggregation , Primary Cell Culture , Signal Transduction , Tumor Suppressor Protein p53 , Genetics , MetabolismABSTRACT
Objective To investigate the detection of early cervical cancer patient's peripheral blood CK19 mRNA and its clinical significance. Methods 30 early (ⅠA2~ⅡA) cervical cancer patients from the department of gynecological tumors in the third affiliated hospital of Kunming Medical University were selected as experimental group, 15 patients with uterine myoma and 15 healthy volunteers as negative control group,15 advanced (ⅡB~ⅢB) cervical cancer patients as positive control group. Peripheral blood samples before receiving radical resection of experimental group,and the same samples before treatment of control groups were collected. The change of relative expression level and positive rate of peripheral blood CK19 was analyzed using qRT-PCR technique, and its correlation with clinicopathological parameters and prognosis was further analyzed. Results There was significant difference in relative expression level of CK19 mRNA in the peripheral blood between experimental group and control groups ( 0.05) . Conclusions CK-19 mRNA is a specific and suitable molecular marker for the detection of circulating tumor cells in early cervical cancer. Detection of peripheral blood CK19 mRNA expression before receiving radical hysterectomy in patients with early cervical cancer can also make up for the disadvantage of other methods such as the imaging, tumor marker detection. Most important of all, it can provide the basis for choosing a proper adjuvant therapy post-operation and estimating the relapse and prognosis.
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BACKGROUND:Laminar flow operating room used in artificial joint replacement can improve the aseptic conditions and can effectively prevent the infections after joint replacement. OBJECTIVE:To compare the number of colonies during artificial joint replacement in laminar flow operation room and traditional operation room. METHODS:300 patients with artificial joint replacement in hundred-level laminar flow operation room and 300 patients with artificial joint replacement in traditional operation room were selected, and al the patients had no infection. Then 100 patients with artificial joint replacement were randomly selected from the hundred-level laminar flow operation room and traditional operation room respectively. The number of colonies in operation room of two groups was compared before and after replacement. RESULTS AND CONCLUSION:There was no significant difference in the number of colonies between two groups before replacement, and the settling bacteria number of the artificial hip replacement patients in the hundred-level laminar flow operation room was significantly smal er than that in the traditional operation room (P<0.05). The results indicate that compared with the traditional operation room, the hundred-level laminar flow operation room for artificial joint replacement has higher safety and can effectively prevent infections after replacement.
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ObjectiveTo explore the possible mechanism that Gadd45a and Egr-1together participate in the DNA damage repair,by analyzing the influence of hepatic ischemia-reperfusion injury (IRI) on the rnRNA and protein expression of hepatic cell cycle-related genes.Method Methods Forty-two SD rats were divided into normal control group,ischemia 30 min group and reperfusion 30 min,1h,2 h,3 h and 24 h groups.The hepatic specimens of rats at the corresponding time points after success of modeling were obtained. Chip experiment was used to screen out the key genes Gadd45a,Egr-1and GAPDH for target genes.We used Northern blot and RT-PCR to confirm the chip's results. The expression of related proteins was detected by using immunofluorescence and immunohistochemistry.Results Northern blot detection results showed that the RT-PCR products and the target genes for testing were concordant.The expression spectral chip signal and RT-PCR detection revealed that the expression of target genes had a 4-fold increase at early reperfusion period (1h) (up-regulation of Egr-1,Gadd45a and HSP70-1a by 9.39,8.28 and10.8 respectively.At the later stage of reperfusion (24 h),the expression of Egr-1,Gadd45a and Hspala was reduced to the normal levels, and the chip screening results were consistent with the RT-PCR test results.Fluorescence immunohistochemistry demonstrated that in the reperfusion1h and 2 h groups,the expression of Egr-1in nuclei of liver cells was positive. Immunohistochemistry indicated that the Gadd45 expression in the nucleus and cytoplasm was gradually increased with increasing reperfusion time.ConclusionGadd45a and Egr-1are the key genes of the nuclear factor (NF)-kB regulatory pathways,and involved in the regulation of cell cycle arrest at G2/M phase and repair of damaged DNA in rat hepatic IRI.
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Objective To evaluate the feasibility, methods and effectiveness of using a mechani-cal stapler for choledochojejunostomy.Methods The authors have operated on 118 patients in the management of carcinoma of head of pancreas, or periampullary tumor, or cholelithiasis.In the opera-tion, the bilio-enteric end-to-side, or end-to-end and side-to-side anastomosis was made by a circular stapler device, and then a Roux-en-Y or Brown's loop was formed for the preeedure.Results All the surgery of using stapler was done successfully.No postoperative complications such as stomal leak, bleeding and narrow were found.Meanwhile, no harmful consequences were observed through long-time follow-up.Conclusion Using mechanical stapler for bilio-intestinal anastomosis is time-saving, simple and reliable.It can be a choice for some diseases.
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<p><b>OBJECTIVE</b>To study the association of single nucleotide polymorphism at interleukin-10 gene 1082 locus with Helicobacter pylori (Hp) infection and the risk of gastric cancer in high prevalent region (Shaanxi Province)aand low prevalence region (Guangdong Province) in China.</p><p><b>METHODS</b>The genomic DNA was extracted from the peripheral blood of 104 healthy individuals, 104 gastric cancer patients from Guangdong Province, and from 102 healthy volunteers and 102 gastric cancer patients in Shaanxi Province, China. The single nucleotide polymorphism at IL-10 gene 1082 locus was analyzed by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). The serum levels of anit-Hp IgG was measured by enzyme-linked immunosorbent assay.</p><p><b>RESULTS</b>The frequencies of IL-10-1082 A/A, A/G and G/G genotypes in the 412 subjects were 86.7%, 10.7% and 2.4%, respectively. In the low prevalence region, the number of carriers of IL-10-1082 G* was much greater in the cancer patients than in the healthy controls (14.4% vs 7.7%, Chi2=4.02, P<0.05, OR=1.01, 95% CI=1.08-3.10). The presence of IL-10-1082 G* was associated with significantly increased risk of gastric cancer following Hp infection (Chi(2)=5.36, P<0.05, OR=6.0, 95% CI=1.23-17.52). In the high prevalence region, the frequency of IL-10-1082 G* was slightly higher among the cancer patients than in the healthy controls, but this difference was not statistically significant (12.7% vs 16.6%, P>0.05).</p><p><b>CONCLUSION</b>The G* genotype of IL-10 gene 1082 locus may be associated with increased risk of gastric cancer in China.</p>
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Aged , Female , Humans , Male , Middle Aged , China , Epidemiology , Gene Frequency , Genotype , Interleukin-10 , Genetics , Polymerase Chain Reaction , Polymorphism, Restriction Fragment Length , Polymorphism, Single Nucleotide , Risk Factors , Stomach Neoplasms , Epidemiology , GeneticsABSTRACT
<p><b>OBJECTIVE</b>To investigate the dose-effect relationship of para-toluenesulfonamide (PTS) for treatment of hepatocellular carcinoma in rats.</p><p><b>METHODS</b>Forty-two SD rats bearing subcutaneous transplanted hepatocellular carcinoma were randomly divided into 6 groups (n=7), in which 0.02, 0.04, 0.06, 0.08, and 0.10 ml PTS and 0.10 ml normal saline were injected into the tumor, respectively. All of the rats were executed 24 h after the injection to observe the pathological changes in the tumor.</p><p><b>RESULTS</b>In rats with saline injection, the tumor tissues exhibited no obvious changes and the tumor cells retained the active proliferation. PTS, in contrast, caused coagulation necrosis of the tumor tissue, and the necrotic area expanded with the increase of the injected doses. The necrotic volume of the tumor was in roughly linear correlation with the dose of PTS injected, with the linear regression equation of V (cm(3))=-0.018+2.595Y (where V represents tumor necrosis volume, and Y the injected dose of PTS).</p><p><b>CONCLUSION</b>The dose-effect relationship of PTS is roughly linear, and the PTS dose for injection can be estimated according to the diameter of the tumor.</p>
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Animals , Rats , Antineoplastic Agents , Therapeutic Uses , Carcinoma, Hepatocellular , Drug Therapy , Pathology , Cell Proliferation , Dose-Response Relationship, Drug , Necrosis , Rats, Sprague-Dawley , Sulfonamides , Therapeutic Uses , Toluene , Therapeutic UsesABSTRACT
<p><b>OBJECTIVE</b>To observe the effect of warm ischemia-reperfusion injury (WIRI) on the genes involved in the cell cycle in liver and investigate the molecular mechanism of WIRI.</p><p><b>METHODS</b>Twenty-four Sprague-Dawley male rats were divided into experiment groups and sham operation group respectively. According to the dynamic characteristics, the genes involved in the cell cycle were submitted for multivariate cluster and self-organized map analysis. Total RNA was extracted for the microarray analysis and subsequent real-time quantitative PCR.</p><p><b>RESULTS</b>There were 86, 410, 234 up-regulated genes and 136, 312, 653 down-regulated genes over 2 - 4 times in the 0 h, 1 h and 24 h group respectively, most of which such as Gadd45a, Egr1, Hsp70 were involved in the cell cycle checkpoint, energy metabolism, signal transduction, immune-associated procedure, and so on. In addition, the results of microarray analysis were confirmed by real-time quantitative PCR.</p><p><b>CONCLUSIONS</b>Some genes related with cell cycle and regeneration were activated in the early stage of WIRI. Gadd45a, Egr1 and Hsp70 may be new targets to cure WIRI.</p>
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Animals , Male , Rats , Cell Cycle , Genetics , Cluster Analysis , Early Growth Response Protein 1 , Genetics , Gene Expression Profiling , Gene Expression Regulation , HSP70 Heat-Shock Proteins , Genetics , Hot Temperature , Liver , Metabolism , Oligonucleotide Array Sequence Analysis , Methods , RNA, Messenger , Genetics , Metabolism , Rats, Sprague-Dawley , Reperfusion Injury , Reverse Transcriptase Polymerase Chain ReactionABSTRACT
<p><b>OBJECTIVE</b>To characterize a mRNA expression profile of unlethal warm ischemic injury in rat livers and to clarify the controlling genes and molecular pathogenesis.</p><p><b>METHODS</b>One group of rats underwent surgeries to make a warm ischemic injury of their livers and another group of rats (controls) had sham operations; then 8 hybridized RNA samples were used in microarray analysis. The data were submitted to public databases, such as Gene Bank, dbEST, Unigene and Refseq, and then batch filtrated. Hierarchical clustering algorithm was applied in analyzing the differential expression genes and individual samples according to GeneCluster 3.0 software.</p><p><b>RESULTS</b>Among the total 8804 probe sets, the expressions of 927 genes were down-regulated and 885 genes were up-regulated in the ischemia group when compared with normal controls. Between them, 40 genes were down-regulated and 29 genes up-regulated more than 3 fold (P less than 0.01); then Hsp70 and CyclinD1 were confirmed by real-time fluorescent quantitative RT-PCR test.</p><p><b>CONCLUSION</b>In the present study, we provide the first report of large-scale changes in hepatic gene expression induced by nonlethal warm ischemic injury. Most of up-regulated genes belong to the groups that are important in maintaining cell structure, division, differentiation, tricarboxylic acid cycle and tissue repair. Discovering such candidate genes of protective effects may be of help to prevent warm ischemic injury and to treat this serious disorder.</p>
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Animals , Male , Rats , Gene Expression Profiling , Gene Expression Regulation , Ischemia , Genetics , Liver Diseases , Genetics , Oligonucleotide Array Sequence Analysis , RNA, Messenger , Genetics , Rats, Sprague-DawleyABSTRACT
<p><b>OBJECTIVE</b>To explore the feasibility and outcome of combined hepatectomy, orthotopic liver transplantation and Whipple's pancreatoduodenectomy for radical excision of cholangiocarcinoma.</p><p><b>METHODS</b>A 35-year-old female patient with unresectable cholangiocarcinoma underwent curative radical operation, which includes hepatectomy, orthotopic liver transplantation and pancreaticoduodenectomy of hilar bile duct carcinoma; immunosuppression followed an induction protocol with FK506 and steroids. Lamivudine and HBIg were used to prevent hepatitis B virus from infection again.</p><p><b>RESULTS</b>Pathologic examination revealed low differentiated cholangiocarcinoma and immunohistochemistry stains demonstrated positive expression of cytokeratin 9 and 17, carcinoembryonic antigen and the hepatocyte protein was negative. Neither the margins of resection nor the periductal lymph nodes were involved. The liver showed evidence of cholestasis and metastasis nod. The patient was hospitalized 32 days and came back to the previous work. He has been followed up for more than 14 months up to now and is currently alive without any evidence of recurrent cancer.</p><p><b>CONCLUSIONS</b>For some selected unresectable Klatskin's tumors, combined hepatectomy, pancreatoduodenectomy and orthotopic liver transplantation was justified. The radical methods maybe provide long-time survival and curative effect. Nevertheless, because of possible tumor recurrence and ethical controversy, the combined hepatectomy, pancreatoduodenectomy and orthotopic liver transplantation procedure has to be applied only with caution and indications.</p>
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Adult , Female , Humans , Bile Duct Neoplasms , Pathology , General Surgery , Bile Ducts, Extrahepatic , General Surgery , Cholangiocarcinoma , Pathology , General Surgery , Follow-Up Studies , Hepatectomy , Liver Transplantation , Pancreaticoduodenectomy , Treatment OutcomeABSTRACT
0.2 g/L)with normal diets. Conclusions Living donor liver transplantation for hepatic complications of Wilson's disease can cure and correct the underlying metabolic defect. It is a lifesaving therapy in children with fulminant Wilsonian hepatitis and has many unsurpassed advantages.
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Objective To investigate the diagnosis and surgical management of Hashimoto's thyroiditis and coexisting disease. Methods The clinical data of 54 patients with Hashimoto's thyroiditis were analyzed retrospectively. Results 25 cases were diagnosed as Hashimoto's disease by clinical physical examination, FNAB and immune antibody assay. Diagnostic treatment with medicine was adopted firstly. Of them 24 cured, one was found coexisting thyroid cancer, and then a radical operation was performed. The other 29 cases had been misdiagnosed as surgical diseases because of atypical features and undergoing thyroidectomy; the diagnosis of Hashimoto's disease had been confirmed by pathology, and some coexistence had been found(hyperthyroidism in 3, thyroid carcinoma in 4, malignant lymphoma in 2, thyroid adenoma in 5). Conclusions Attention should be paid to the atypical Hashimoto's disease. FNAB, immune antibody assay, diagnostic treatment, operative exploration and biopsy would be helpful to make the sound diagnoses of Hashimoto thyroiditis and the disease in coexistence, which ought to be operated on corresopondingly.
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Objective To evaluate the surgical technique and outcome of the extended radical resections for hilar cholangiocarcinoma.Methods A patient with Bismuth-Corlette type Ⅳ Klatskin's tumor, which invaded the secondary intrahepatic bile duct and the pancreatic portion along the common bile duct, underwent the HPLT_ X . And then, the digest cannel was reconstructed according to the Child's methods. By using immunohistochemistry, the expression of cytokeratin9, 17, CEA and hepatocyte protein was detected. After operation, the immunosuppressive agents consisting of Tacrolimus and steroids were given; lamivudine and HBIg were used to prevent HBV from recurrence.Results Pathologic examination revealed low differentiated adenocarcinoma and immunohistochemistry stains confirmed the positive expression of cytokeratin9 and 17, carcinoembryonic antigen, and the negative expression of hepatocyte protein. Neither the margins of resection nor periductal lymph nodes were pathologically involved. She was currently alive for 17 months after the operation, the liver graft function was within normal range, and the patient was back to the previous work without any evidence of recurrent cancer. The tumor marker in plasma was decreased to the controllable level.Conclusion The HPLT_ X may be the treatment choice for unresectable Klatskin's tumor and provide the higher rate of radical resection and better prognosis.